Single-Access Gastrostomy (SAG) Dispenses Endoscopy or Laparoscopy: A Simple Method Under Local Anesthesia

Abstract

Objective. Gastrostomy for feeding or desobstructive purposes is often performed transendoscopically. However, as endoscopy specialists and instruments are not widely available in community hospitals in Brazil, an alternative method was developed at the authors’ institution. Surgical single-access gastrostomy (SAG), performed under local anesthesia and requiring no endoscopic guidance is described. Methods. The authors used the SAG technique on 19 patients eligible for gastrostomy, and the data were prospectively documented. After local anesthesia and a 1-cm incision, the gastric wall was localized under direct vision. Purse string sutures were placed to work as a fixed valve to rectus sheath. Results. SAG was feasible in all patients. Minor complications occurred in 3 patients. The mean operative time was 44.2 minutes, and the mean institution of gastrostomy feeding was 27.8 hours. Conclusion. SAG may dispense with the use of endoscopy and laparoscopy, providing a feasible, reproducible, and effective feeding gastrostomy in developing countries where alternative methods are not available.